Pain and stiffness of the joints is best relieved by hot-water bags, hot fomentations, and friction. The prolonged hot spray and hot pour we have also used to very great advantage. In his article on this disease, Prof. Niemeyer remarks that the douche applied to the affected part is a much more effective derivative than the hot iron, which is often recommended, together with plasters and other irritants. When the pain in the joint is very severe, and the inflammation great, some physicians recommend the employment of a freezing mixture of snow or pounded ice and salt. The .joint should be protected by thin muslin, and surrounded by the mixture. The application should not be continued more than five minutes, but may be repeated. It should not be employed more than twice a day. It almost always gives immediate relief.

The various liniments which have been recommended are generally effective only by means of the rubbing by which they are applied. This view we have often confirmed by our own experience. The pains at night are generally relieved by wrapping the affected joints in moist flannels, which are covered with dry cloths, or oiled silk. We have often recommended patients, in whom the disease was chiefly confined to the hands, to wear upon the hands at night large cloth mittens, filled with oatmeal or corn-meal mush and tied about the wrist. We have often seen excellent results from this simple plan of treatment. It acts upon the same principle as the warm packing of the joints, a remedy which has in our hands proved more effective than any other in relieving the pain and tenderness, and removing stiffness. The general condition of the system, on which the disease of the joints depends, will be best relieved by the employment of the wet-sheet pack, the vapor, hot air, Turkish or Russian baths, and other eliminative measures. Some one of these modes of treatment may be employed daily to advantage, when the patient is strong enough to bear severe treatment, and in some cases will need to be continued for months. We have frequently been taught the importance of persevering, even in apparently hopeless cases, by seeing patients recover under this treatment, after the employment of a great variety of remedies for years without any apparent benefit, indeed, without even checking the progress of the disease. The great reputation enjoyed by some mineral springs in the treatment of rheumatism, particularly by the hot springs of Arkansas, and other thermal springs, is due to the active elimination which is induced by the hot baths. We have, however, successfully treated cases which have remained under treatment at these celebrated resorts for months without benefit, and had almost totally despaired of recovery.

We have found, in some cases, great advantage from the use of local applications of electricity to the affected joints while the patient was in a warm bath, as in a Turkish, hot-air, or vapor bath; and a combination of electricity, particularly of faradic electricity, with the warm water bath, is also a very effective means of relieving pain in the joints. The application of a strong galvanic current to the affected joints, daily, or every other day, has proved very successful in some cases. We consider inunction a very important adjunct to the treatment, especially in cold weather, as it in some degree protects the patient from the results of exposure to alternations of temperature. Such exposure should be avoided, however, as much as possible, as it is very important that the temperature to which the body is subjected should be kept as uniform as possible. The body should be clothed in flannel, and the affected joints should be protected with extra covering. The tendency to stiffness of the joints should be counteracted by daily manipulations to as great an extent as possible without exciting too great increase of pain. The patient should resist as much as possible the tendency to bend up the limbs and joints which are affected. In case the knee joints axe affected, the tendency to stiffening in a flexed condition may be prevented by elevating the foot when sitting.

The diet of the patient should be nutritious, but as free as possible from meat and all highly nitrogenous food. Tea, coffee, tobacco, and alcoholic liquors and stimulating condiments should be carefully avoided. Salt should be used as little as possible. Some authors warn patients against the use of raw fruits, particularly apples, pie-plant and asparagus. As a general rule, the coarse vegetables should be avoided. A patient suffering with flatulent dyspepsia, or other forms of indigestion, should follow the rules which have been laid down elsewhere.